Impact of Imaging Manifestations of Tumor Growth Patterns on the Prognosis of Osteosarcoma
Objective To investigate the correlation between the growth pattern of osteosarcoma and the prognosis of patients.Methods The medical records of patients diagnosed with extremity osteosarcoma were collected at the 960th Hospital of the People's Liberation Army of China from January 2007 to August 2018.Patients with osteosarcoma were classified into 3 types based on the growth patterns revealed by MR1 images:homogeneous growth type,progressive growth type,and longitudinal growth type.Fisher's exact test was used to analyze the correlation between the growth patterns of osteosarcoma and the clinical characteristics of patients.The 5-year event-free survival rate and the 5-year overall survival rate of the patients were analyzed using the Kaplan-Meier method,and their survival differences were assessed by Log-rank analysis.The Cox proportional hazards model was employed for multivariate analysis.Results There were 44 cases(37％)of homogeneous growth type,35 cases(30％)of progressive growth type,and 40 cases(33％)of longitudinal growth type.Among the three types of osteosarcoma patients,those with the longitudinal growth type had the highest rate of metastasis at the time of initial diagnosis(x2=14.615,P=0.001);Tumors of the homogeneous growth type were relatively small in volume,while those of the longitudinal growth type were larger.Tumors of the progressive growth type had volumes that fell between the two(x2=29.322,P＜0.001).The chemotherapy efficacy was superior for tumors of the homogeneous growth type to those of the progressive and longitudinal growth types(x2=6.640,P=0.035).The local recurrence rate was low for tumors of the homogeneous growth type,while it was higher for tumors of the progressive and longitudinal growth types(x2=8.005,P=0.023).The rate of distant metastasis was high for tumors of the longitudinal growth type,followed by the progressive growth type,while it was lowest for tumors of the homogeneous growth type(x2=6.708,P=0.037);The 5-year overall survival rates for the homogeneous growth type,progressive growth type,and longitudinal growth type were 72.7％,65.7％,and 50.0％,respectively(x2=17.407,P＜0.001).The 5-year event-free survival rates for the uniform growth type,progressive growth type,and longitudinal growth type were 63.6％,51.4％,and 37.5％,respectively(x2=15.477,P＜0.001).The multifactorial prognostic analysis indicated that the tumor growth pattern,tumor volume,tumor volume ratio,and Enneking staging were significantly correlated with patient survival and were independent prognostic factors(P＜0.05).Conclusion The growth pattern of osteosarcoma can serve as one of the important references for predicting the prognosis of osteosarcoma,with the homogeneous growth type having a better prognosis,followed by the progressive growth type,and the longitudinal growth type having a poorest prognosis.
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